Search Results (187)

Background: Micro- and nanoplastics (MNPs) are widespread environmental contaminants with growing evidence linking them to adverse health effects, including progression and worsening of allergic diseases. As allergies are rapidly increasing among youth (affecting almost 30% of children), this demographic represents a vulnerable population facing emerging environmental threats. Since no prior study has investigated MNP risks perceptions in an allergic population, this study aimed to assess public awareness and risk perception of MNP in Croatian youth, focusing on the influence of urbanicity, education, and allergy status. Methods: A total of 1155 participants (aged 6–18 years) were recruited from three Croatian regions as part of the EU Horizon 2020 IMPTOX and the Horizon Europe EDIAQI studies. Allergy status was determined via skin prick tests (SPT), and standardized questionnaires were used to collect data on MNP awareness and perception. Results: Awareness was significantly higher among allergic individuals (89.5% vs. non-allergic 79%, FDR p value= 0.036) and those with university-level education (88.3% vs. elementary 63.3%, FDR p value = 0.050). Allergic participants were also more concerned about food contamination by MNPs (87.7%) compared to non-allergic individuals (79.2%), FDR p value = 0.005). Media and social media were the primary sources of information regarding MNPs (FDR p value = 0.026). Conclusions: Education and allergy status are the strongest predictors of MNP awareness and related risk perceptions in the Croatian population. Targeted public health communication and educational strategies are needed to translate basic awareness into informed behavioral and policy engagement. Full article

Ragweed (Ambrosia artemisiifolia) represents a major and expanding source of aeroallergen exposure in Europe, with rising sensitization rates and substantial clinical impact. However, population-level data integrating airborne pollen exposure with detailed clinical sensitization patterns remain limited. We conducted a 5-year retrospective cross-sectional observational analysis of sensitization prevalence, complemented by a parallel temporal analysis of aerobiological data and symptom-driven healthcare presentation patterns (2020–2024) in Timisoara, Romania, including all patients undergoing first-time sensitization evaluation at a tertiary referral hospital. Sensitization was assessed using standardized skin prick testing to common aeroallergens and other allergen categories, while airborne ragweed pollen concentrations were monitored through a peri-urban network of real-time bio-particle analyzers. Statistical analyses included descriptive statistics, multivariable logistic regression, χ² tests for co-sensitization patterns, and comparative analyses of clinical manifestations across sensitization profiles. Among 4404 eligible patients, 50.7% were sensitized to at least one allergen. Ragweed sensitization was identified in 24.1% of patients, with a mean age of 31.1 years at diagnosis and no significant sex-related difference. Most ragweed-sensitized patients were polysensitized (71.5%), predominantly to other aeroallergens. Increasing age was independently associated with lower odds of polysensitization to other aeroallergens (adjusted OR = 0.97 per year, 95% CI: 0.96–0.98), while sex showed no independent association. Patients with ragweed sensitization alone and those cosensitized with aeroallergens exhibited similar prevalence of respiratory manifestations, whereas individuals with additional non-aeroallergen sensitization showed lower prevalence of rhinitis, conjunctivitis, and asthma but slightly higher rates of asthma exacerbations. Weekly diagnoses of ragweed sensitization demonstrated a pronounced seasonal peak between calendar weeks 33 and 38 (mid-August to late September), coinciding with peak airborne ragweed pollen concentrations. Ragweed sensitization therefore represents a substantial and seasonally driven healthcare burden in western Romania, characterized by frequent polysensitization, distinct clinical manifestation patterns across sensitization profiles, and close temporal alignment between airborne pollen exposure and clinical presentation. Integrating aerobiological monitoring with clinical surveillance may support targeted prevention strategies and improved patient management. Full article

Peanut allergy (PA) remains a major diagnostic challenge in pediatric allergy, largely due to the frequent discrepancy between immunological sensitization and clinically relevant disease. This study aimed to develop a real-life diagnostic prediction model to distinguish true peanut allergy from asymptomatic peanut sensitization in children referred for evaluation of suspected PA. In this cross-sectional study, 80 children aged 1–18 years were assessed in a tertiary allergy center in Poland. Sixty-five children with peanut sensitization underwent detailed clinical history assessment, skin prick testing, measurement of serum specific IgE including component-resolved diagnostics, basophil activation testing, and oral food challenges where clinically indicated. Clinically confirmed peanut allergy was diagnosed in 42 sensitized children. In univariate analyses, several clinical and immunological factors were associated with PA, including atopic comorbidities, peanut component sensitization, and basophil activation. Multivariate analysis identified food-induced anaphylaxis and walnut sensitization as independent factors associated with PA. In addition, a penalized diagnostic prediction model was developed to support clinical risk stratification. A multivariable diagnostic prediction model integrating clinical history and laboratory parameters demonstrated good discriminative performance in internal validation (area under the ROC curve 0.83). In conclusion, peanut allergy in sensitized children is determined by a combination of clinical and immunological factors rather than a single biomarker. Integrative diagnostic models may support risk stratification and help optimize the use of oral food challenges in specialized clinical settings, although external validation is required before broader implementation. Full article

Background: Almond is one of the most widely consumed tree nuts worldwide; however, almond allergy remains poorly characterized. Despite frequent sensitization, the prevalence of clinically relevant almond allergy appears low, contributing to diagnostic uncertainty. This review summarizes current evidence on the epidemiology, clinical manifestations, and diagnostic challenges of almond allergy. Methods: A narrative review was conducted using PubMed, Scopus, and UpToDate databases. Studies reporting almond-specific data on epidemiology, diagnostics, molecular allergens, and oral food challenge (OFC) outcomes were included. Results: Across heterogeneous studies, clinically confirmed almond allergy appears to be uncommon despite high rates of sensitization, particularly among patients with atopic dermatitis and concomitant tree nut allergy. In sensitized individuals, OFC positivity ranges from 4% to 33%, with anaphylaxis and severe reactions reported in 0.5–12.2% of challenged patients. Conventional diagnostic tests, including skin prick testing and almond-specific IgE, demonstrate limited predictive value, with no reliable cut-off levels for predicting clinical reactivity. Consequently, OFC remains essential for definitive diagnosis. Clinical outcomes vary according to age, ethnicity, and almond processing, with lower OFC positivity observed in pediatric cohorts and reduced reactivity to processed almond products. Conclusions: Almond allergy is relatively rare despite frequent sensitization. Improved almond-specific molecular diagnostics may enhance risk stratification and reduce unnecessary dietary avoidance. Full article

Background: Skin prick testing (SPT) and serum egg white–specific IgE (sIgE) support oral food challenge (OFC) decisions in suspected egg allergy, but the incremental value of histamine-normalized SPT indices remains uncertain. Methods: In this single-center retrospective study, 105 egg-sensitized children underwent clinically indicated OFC. Commercial egg white SPT, prick-to-prick testing with fresh egg white, histamine controls, and serum egg white–specific IgE were assessed. Discriminatory performance was evaluated by ROC analysis, and independent predictors of OFC positivity were identified using multivariable logistic regression. Results: OFC was positive in 23 of 105 children (21.9%). Egg white SPT wheal diameter, the prick-to-histamine ratio, and serum egg white–specific IgE (sIgE) levels were significantly higher in OFC-positive patients (all p < 0.001). ROC analysis demonstrated moderate-to-good discrimination for both sIgE (AUC = 0.767) and the prick-to-histamine ratio (AUC = 0.786), without clear superiority of normalized indices. In multivariable logistic regression analysis, only absolute egg white SPT wheal diameter (adjusted OR 1.41 per 1 mm increase; 95% CI 1.13–1.77) and serum egg white–specific IgE level (adjusted OR 31.86 per 100 kUA/L increase; 95% CI 1.60–636.15) remained independent predictors of OFC positivity. Conclusions: Absolute egg white SPT wheal diameter and serum sIgE independently predict OFC outcomes in egg-sensitized children. Histamine-normalized indices did not provide added value over wheal size alone. These findings support a probabilistic, context-based use of test results to inform selective OFC planning rather than replace OFC. Full article

Background/Objectives: Food allergy (FA) is a substantial health burden in children. FA is often associated with malnutrition and malabsorption, due to restrictive food avoidance diets, which can significantly impair the patient’s and their family’s quality of life. To this date, population-based data combining sensitization and clinical allergy remain limited. This study aimed to assess the patterns of sensitization rates to food and food allergy prevalence rates in Croatian children and to evaluate differences according to age, sex, and region of origin. Materials and Methods: In this cross-sectional study, 1948 preschool and school-aged children from three Croatian regions (Zagreb, Dalmatia, and Slavonia) were included. Participants underwent skin prick testing to common food and inhalant allergens. Data on personal and family medical history were collected using questionnaires and medical records. FA prevalence was evaluated using self-reported data in school-aged children and physician-diagnosed FA data in preschool children. Results: Overall, 41% of participants were sensitized to at least one allergen, while 13% were sensitized to at least one food allergen. Tree nuts—particularly hazelnut—were the most common food-derived sensitizers, followed by hen’s egg, cow’s milk, and fish. Boys exhibited higher total sensitization rates than girls (44.2% vs. 37.5%; p = 0.001), higher food allergen sensitization rates (14.7% vs. 11.4%; p = 0.037), and higher total polysensitization rates (30.7% vs. 22.6%; p < 0.001). School-aged children showed higher total sensitization (44.8% vs. 33.4%; p < 0.001) and polysensitization rates (29.8% vs. 20.5%; p < 0.001) than preschool children, while sensitization to food allergens did not differ between age groups. Food allergen sensitization rates differed by region, with higher prevalence in Zagreb compared with Dalmatia and Slavonia (p = 0.0055), whereas total sensitization rates did not differ regionally. The agreement between sensitization and self-reported FA among school-aged children was low (κ = 0.22; p < 0.001), as was the agreement between sensitization and physician-diagnosed FA in preschool children (κ = 0.13; p < 0.001), despite high specificity in both analyses (95% and 99%%, respectively). Conclusions: Allergic sensitization is common among Croatian children, but it poorly predicts clinically relevant food allergy. These findings highlight the multifactorial nature of allergen sensitization in children and emphasize the need for improvements in diagnostic pathways, targeted prevention strategies, and continued surveillance to optimize allergy prevention and management in children. Full article

Background: Food allergy (FA) is an emerging problem in pediatrics, with tree nuts and peanuts being frequent causes of severe reactions. Oral food challenge (OFC) remains the gold standard for diagnosing FA. However, it is a stressful treatment and not always risk-free. Objectives: To identify potential biomarkers, using component-resolved diagnosis (CRD) associated with OFC outcome in children with tree nut (hazelnut, walnut, almond, and pistachio) and peanut allergy, who live in central and southern Italy. Methods: Eighty-eight (1–18 years) children followed at the Pediatric Allergy Clinic of Policlinico Umberto I in Rome were included in this study. All patients underwent skin prick tests (SPTs), prick-by-prick (PbP) tests, and serum-specific Immunoglobulin E (sIgE) measurement to allergenic components using CRDs. Results: In hazelnut allergy (n = 60 OFCs), OFC failure occurred in 41 children. Higher sIgE levels to Cor a 8 (OR 2.04, 95% CI 1.17–3.55), Cor a 9 (OR 2.61, 95% CI 1.37–5.00), and Cor a 14 (OR 1.65, 95% CI 1.14–2.38) were all significantly associated with an increased probability of a positive OFC outcome. In peanut allergy (n = 30 OFCs), OFC failure occurred in 16 children. Ara h 9 was the only statistically significant predictor of OFC failure, showing a very wide confidence interval (OR, 95% CI: 1.116–484). For walnut, almond, and pistachio, sample sizes were insufficient to support inferential modeling. Conclusions: CRD biomarkers can stratify the likelihood of OFC reactions in pediatric FA, enhancing clinical decision-making and reducing unnecessary challenges. Full article

Food allergy diagnosis remains challenging due to the difficulty of distinguishing true clinical allergy from asymptomatic sensitization. Inaccurate diagnosis may result in unnecessary dietary restrictions, reduced quality of life, or, conversely, failure to identify individuals at risk of severe allergic reactions. This review critically analyzes the efficacy, limitations, and clinical utility of currently available diagnostic tests for food allergy, with particular emphasis on their ability to predict true clinical reactivity. A comprehensive literature review was conducted to evaluate the sensitivity, specificity, and predictive values of both traditional and emerging diagnostic modalities. English-language guidelines, systematic reviews, and key clinical studies published primarily within the past 15 years (up to 2025) were identified through PubMed and Google Scholar. Classic diagnostic tools, including skin prick testing (SPT) and serum-specific IgE (sIgE), were assessed alongside novel approaches such as component-resolved diagnostics (CRD), basophil activation test (BAT), mast cell activation test (MAT), atopy patch testing (APT), cytokine profiling, and omics-based diagnostics. Particular attention was given to how these tests compare with the oral food challenge (OFC), which remains the diagnostic gold standard. The findings demonstrate that while conventional tests offer high sensitivity and are valuable for initial risk assessment, their limited specificity often leads to overdiagnosis. Emerging molecular and cellular assays show improved specificity and functional relevance, especially in complex cases involving polysensitization or unclear clinical histories and may reduce reliance on OFCs in the future. However, accessibility, cost, and lack of standardization currently limit their widespread clinical application. Advances in artificial intelligence and data integration hold promise for improving diagnostic accuracy through enhanced interpretation of complex immunological data. Based on the synthesized evidence, this review proposes an evidence-based, stepwise, and individualized diagnostic algorithm for food allergy. Integrating clinical history, targeted testing, and selective use of OFCs can improve diagnostic certainty, enhance food safety, minimize unnecessary dietary avoidance, and optimize patient outcomes. The review underscores the need for continued research, standardization, and validation of novel diagnostic tools to support personalized and precise food allergy management. Full article

Background: Food allergy is a leading cause of severe allergic reactions in children and often results in restrictive elimination diets. The oral food challenge (OFC) remains the diagnostic gold standard but is resource-intensive and carries a risk of adverse reactions. This study aimed to identify epidemiological, clinical, and laboratory predictors of OFC outcomes and reaction severity in children with suspected immediate-type food allergies. Methods: We conducted a retrospective review of 148 children who underwent hospital-based, open OFCs due to suspected immediate-type food reactions. Data on demographics, comorbidities, characteristics of the initial reaction, sensitisation profiles (specific IgE [sIgE], skin prick test [SPT]), and OFC outcomes were analysed. Reactions were graded using the Ring and Messmer scale. Results: OFC was positive in 44 of 148 children (29.7%). However, no clinical or laboratory parameters—including prior reaction severity and the magnitude of allergy test results—were associated with the severity of reactions during OFC. Comorbidities—specifically asthma, atopic dermatitis, and allergic rhinitis—were significantly associated with a positive OFC (p < 0.01), as were elevated sIgE levels and larger SPT wheal diameters (p < 0.01 for both). The optimal thresholds for predicting a positive OFC were 0.73 IU/mL for sIgE and 3.5 mm for SPT. Conclusions: Oral food challenge (OFC) remains essential for confirming food allergies in children. Given that the severity of reactions during OFCs cannot be reliably predicted and that low cut-off values of allergy tests were identified for predicting a positive OFC outcome, OFCs should be performed in a controlled and fully equipped medical setting, particularly in children with atopic comorbidities. Full article

Background: Diagnosing peanut allergy (PA) in children without known exposure remains challenging due to the need to distinguish true clinical allergy from asymptomatic sensitization. This study aimed to evaluate the diagnostic performance of individual and combined in vitro markers, particularly sIgE to Ara h 2, and to develop a multistage decision pathway that may reduce reliance on oral food challenge (OFC). Methods: Eighty children with suspected peanut allergy were prospectively enrolled. All participants, including healthy controls, underwent skin prick testing (SPT), measurement of sIgE to peanut and Ara h 2, and basophil activation testing (BAT). A multistage diagnostic algorithm incorporating these markers was constructed, and its performance was assessed using ROC analysis, predictive values, and likelihood ratios. A secondary analysis evaluated a simplified decision pathway excluding BAT. Results: sIgE to Ara h 2 demonstrated excellent individual performance (AUC 0.889), with 96.6% PPV at the optimal cut-off. The full multistage decision pathway (SPT + sIgE + BAT when interpretable) achieved 100% specificity and avoided OFC in 28.6% of children. However, BAT feasibility was limited; over 25% of results were uninterpretable. The simplified decision pathway (SPT + sIgE to Ara h 2) preserved 100% specificity and enabled the avoidance of OFC in 27.5% of cases, with slightly lower sensitivity. Conclusions: A structured in vitro diagnostic approach using sIgE to Ara h 2 and SPT can reliably identify peanut allergy in selected pediatric patients, particularly those without a reliable peanut exposure history. BAT enhances specificity but should be considered a confirmatory tool due to feasibility limitations. Full article

Aeromycoflora present in the library environment is known to play a significant role in triggering allergies and contributing to the deterioration of both cellulosic and non-cellulosic materials within the intramural setting of the Midnapore College Library. Fungal spores not only accelerate the aging and degradation of books but also pose considerable health risks to students, library visitors, and staff. In total, 480 fungal colonies belonging to 15 genera and 28 species were recorded using the culture plate exposure method. The predominant taxa included Aspergillus/Penicillium, Alternaria alternata, Alternaria solani, Cladosporium cladosporioides, Curvularia lunata, Penicillium oxalicum, Epicoccum sp., Fusarium solanii, Fusarium oxysporum, Periconia sp., Rhizopus sp., and other Penicillium species. Many of these fungi are well-documented allergens and have been reported to cause adverse health manifestations—such as respiratory discomfort and skin irritation—among students, teaching staff, and book handlers exposed to airborne mycobiota. The present study aimed to investigate the aeromycological diversity within the Midnapore College Library and to conduct immuno-clinical assessments to identify specific serum IgE using both in vivo and in vitro diagnostic techniques. Individuals frequently visiting the library reported symptoms including eye irritation, headaches, itchy skin, sore throat, and severe asthma. Spearman’s rank correlation analysis revealed a significant association between total and dominant spore concentrations and the health status of affected individuals. Clinico-immunological evaluations confirmed the allergenicity of Aspergillus fumigatus, with 39.5% of atopic individuals showing positive reactions in skin prick tests (SPT). Additionally, three novel sero-reactive proteins were identified, offering valuable insights for local clinicians in diagnosing and managing fungal-induced allergic conditions. Full article

Background: Pediatric patients with beta-thalassemia (BT) face unique immunologic challenges due to chronic transfusions and viral exposure. Hepatitis C virus (HCV), a common infection in polytransfused individuals, may influence immune polarization. However, the combined effect of chronic HCV and host immunogenetics on allergic sensitization remains incompletely understood. Objective: To assess total serum IgE levels and allergic manifestations in HCV-positive vs. HCV-negative BT patients, and explore associations with common polymorphisms in IL10, TLR7, IL4, and IFNG genes Methods: This cross-sectional observational study enrolled 46 BT patients (37 HCV-positive, 9 HCV-negative) and 50 healthy controls. Clinical allergy history, total IgE levels (ELISA), and skin prick tests (SPT) for aeroallergens were collected. Genotyping for IL10 −1082, TLR7 rs179008, IL4 −589, and IFNG +874 polymorphisms was performed. Associations between genotypes, HCV status, and IgE levels were analyzed descriptively due to small sample size Results: HCV-positive BT patients had lower mean IgE levels (18.73 ± 4.2 IU/mL) and fewer reported allergic symptoms (21.6%) compared to HCV-negative counterparts (118.76 ± 7.9 IU/mL; 55.5%). The IL10 −1082 AA and TLR7 rs179008 TT genotypes were more common in the HCV-positive group and were associated with lower IgE levels. No associations were noted for IL4 or IFNG variants. Splenectomy appeared to further modify IgE levels in HCV-negative patients. Due to limited power and absence of multivariate analysis, findings are exploratory. These preliminary observations may inform future studies of immune deviation in chronically infected pediatric cohorts. Conclusions: Chronic HCV infection may contribute to immune tolerance and reduced allergic expression in BT patients, potentially modulated by IL10 and TLR7 genotypes. Further studies with functional immune profiling and larger cohorts are required. Full article

Background/Objectives: Cow’s milk allergy (CMA) manifests with various clinical syndromes and has a wide range of symptoms in infants. This study aims to investigate the prevalence, clinical presentation, and outcome of clinical types and subtypes of CMA diagnosed in children within the first 12 months of life. Methods: Children with a CMA diagnosis were included in this mixed retrospective and prospective cohort study and were followed up for four years. Data recorded included clinical manifestations, feeding modes, and outcomes. Follow-up included oral cow’s milk (CM) challenge and/or elimination—reintroduction of CM, provided there was parental consent. Also, skin prick test and serum CM-specific IgE were assessed when needed. Results: A total of 93 infants (age: 3 days to 24 months) diagnosed with CMA were included. Prevalence was 28% for IgE-mediated CMA and 72%, 49.5%, 18.3%, and 3.7% for non-IgE-mediated CMA and its subtypes, Allergic Proctocolitis (AP), Food Protein induced Enteropathy (FPE), and Food Protein Induced Enterocolitis Syndrome (FPIES), respectively. Main manifestations were gastrointestinal (74%), skin rash (31%), failure to thrive (11.8%), feeding aversion (15.1%), respiratory symptoms (5.4%), and irritability/restlessness (9.7%). Follow-up revealed a high rate of AP and FPE tolerance within the first year, while FPIES and IgE-mediated CMA achieved tolerance at an older age. Conclusions: Our study demonstrated the predominance of AP and increased incidence of gastrointestinal involvement. Outcome was good for AP and FPE but less favorable for FPIES and IgE-mediated CMA. Our results, combined with published data, could increase our understanding of CMA-associated syndromes in infants and contribute to the guidance of effective management. Full article

Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are common comorbid sinonasal conditions. CRS is classically divided into two distinct phenotypes: CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP). The purpose of this retrospective observational study is to determine whether aeroallergen sensitization profiles in patients with comorbid CRS and AR can distinguish between CRSwNP and CRSsNP. A total of 241 patients diagnosed with comorbid CRS and AR who underwent skin prick testing or in vitro allergy testing in a single tertiary rhinology practice were included for evaluation. The rates of allergen-specific sensitizations in CRSwNP patients were compared with those in CRSsNP patients. Of the allergens tested in the routine panels, Dermatophagoides pteronyssinus (OR = 1.82, p = 0.03), Alternaria (OR = 2.55, p < 0.01), and animal dander (OR = 1.48 for cat and OR = 3.01 for dog, p < 0.01) were predictive of CRSwNP. Sensitization to any grass allergen was also predictive of CRSwNP (OR = 2.09, p < 0.01). Multiple perennial aeroallergens showed strong associations with CRSwNP; however, broad sensitization to perennial allergens as a whole group was not significantly predictive of CRSwNP (OR = 1.83, p = 0.22). Full article

Given their nutritional features and environmental sustainability, black soldier fly (Hermetia illucens) larvae are currently being considered in Europe for commercialization as human food. The primary goal of this study is the determination of in vitro IgE-cross-reactivity to recombinant tropomyosin (_HITPM) and arginine kinase (_HIAK) of H. illucens in subjects sensitized to crustaceans and/or mites. Dot blot assays for recombinant _HITPM were carried out with the sera of 48 subjects, 30 sensitized to crustaceans (Cr+) and/or house dust mites (HDM+) (STUDY group) and 18 non-sensitized (CTRL group). A higher rate of IgE-reactivity to recombinant _HITPM was found in the STUDY group compared to non-sensitized controls (73% vs. 44%; p 0.066). No significant relationship was achieved upon dot blot assays for _HIAK. No relevant association between a positive history of food reactions and immunoreactivity to _HITPM and to _HIAK was reported (15% in _HITPM+ vs. 6% in _HITPM-, p NS; 28% in _HIAK+ vs. 50% in _HIAK-, p NS), contrary to the _HITPM+Cr+HDM+ subset (50% vs. 0%, p 0.022). Considering the wide overlap of pan-allergens within the Arthropoda phylum, concerns about allergenic potential due to the eventual consumption of H. illucens-enriched foods might be valid. Therefore, targeted studies involving basophil activation tests, skin prick tests, and a double-blind placebo-controlled oral food challenge using H. illucens are needed. Full article